indiacancer.org - Mesothelioma

Mesothelioma

		What is the Pleura?
		What is the Peritoneum?
		What is Malignant Mesothelioma?
		How do Malignant Mesotheliomas present?
		How are Malignant Mesotheliomas detected?
		What are staging and grading?
		How is Malignant Mesothelioma treated?
		What are the side effects of treatment for Mesothelioma?
		What is the importance of follow up?
		Mesothelioma HQ: categorized resource directory for everything about mesothelioma.

What is the Pleura?

The pleura is a special sac lining the chest, which houses the lungs inside. Between its layers, it contains a thin layer of lubricating fluid.

The Chest Cavity (The Pleura lines the rib cage and the organs in the center)

What is the Peritoneum?

The peritoneum, just like the pleura, is that lining of the abdominal cavity, which houses various organs. It also has the same quality of lubrication inside its two layers.

What is Malignant Mesothelioma?

Malignant mesothelioma is a very rare cancer, which arises from the cells of the pleura or the peritoneum.

How do Malignant Mesotheliomas present?

	Usually, the patient may present with:
		Shortness of breath.
		Pain in the chest, especially during breathing.
		A pain or swelling in the abdomen.
	A clue to the history and the findings may also be added if the patient has lost his job, which involved asbestos, in which asbestos could possibly have been inhaled.

How are Malignant Mesotheliomas detected?

If the above symptoms present, the doctor may order a series of x-rays of the chest or abdomen.

He also may order other imaging tests such as:

ULTRASONOGRAPHY is the use of very high frequency sound waves that cannot be heard by the human ear. The ultrasound instrument sends sound waves into the patient's abdomen. The waves bounce off the internal organs and produce echoes that create a picture called a sonogram. Healthy tissues and organs produce different echoes from diseased tissues and organs.

CAT (computer assisted tomography) scans are produced when the X-ray machine is linked to a computer. The X-ray machine is shaped like a large doughnut (Vada) with a hole. The patient lies on a bed which passes through this hole. As the patients body goes through it, the machine takes X-rays of different parts of the body. The computer then puts the X-ray pictures together to produce detailed, three dimensional pictures.

MRI(Magnetic Resonance Imaging) uses a powerful magnet linked to a computer. This large machine has space for the patient to lie in a tunnel inside the magnet. The machine measures the body's response to the magnetic field. The computer uses this information to create detailed, three dimensional pictures of areas inside the body.

The doctor may also look inside the chest cavity using a special instrument called a thoracoscope. A thoracoscope is a rigid, tubular structure with an illumination port, which is introduced into the chest wall between any two ribs and then the pleural cavity is examined for lesions. The procedure is usually done under a local anesthetic, which acts for a short period of time and only causes a local loss of sensation.

A similar procedure to look into the peritoneal cavity is called a peritoneoscopy. The instrument used is called a peritoneoscope.

If the doctor discovers tissue which is abnormal, then he may take out a small piece from that area and this procedure is called a biopsy. The tissue specimen is then examined by a pathologist under the microscope to look for the absence or presence of cancer cells.

	What are staging and grading?

These are terms with which you must become familiar, if you are dealing with any form of cancer.

When we stage a cancer, we try to establish carefully degree of spread of the cancer and if indeed there is spread, to what extent and involving which organs.

The grading of a cancer is a microscopic issue, in which the pathologist lets you know how aggressive this particular type of cancer is; well differentiated means less aggressive, moderately differentiated intermediately aggressive and poorly differentiated more aggressive.

Both grading and staging help your clinician to establish the prognosis or how serious your disease is and what is going to be the likely outcome.

Staging may require additional imaging tests such as CT Scan, MRI, Sonography of the abdomen, IVU, Bone scan or chest X-ray.

The general staging and grading for malignant mesotheliomas are as follows:

Localized malignant mesotheliomas

Stage I: The cancer is found in the lining of the chest cavity near the lung, heart or the diaphragm (a thin muscle which helps us breathe and separates the chest from the abdominal cavity).

Advanced malignant mesothelioma

Stage II: The cancer is now beyond the lining of the chest and has gone to the lymph nodes in the chest. (Lymph nodes are small bean-shaped structures, which act as stations for drainage of lymph, a clear watery fluid, which courses through out the body in transparent, thin tubes called lymph channels or lymphatics, from various organs).

Stage III: The cancer involves the chest wall, the center of the chest, the heart and has gone through the diaphragm or abdominal lining and then in some cases entered nearby lymph nodes.

Stage III to IV: The disease has gone to distant organs and tissues.

Recurrent malignant mesothelioma. This is a disease which has come back after the primary therapy for the mesothelioma is over. It may recur in the original locus itself or in other parts of the body.

The same staging is true for peritoneum as well.

How is Malignant Mesothelioma treated?

A lot depends on the patient's constitution, the grade of his disease, and its staging. Patients are usually treated by a team of specialists, which utilizes a multipronged approach. This includes an otorhinolaryngologist (ENT surgeon), a surgical oncologist, a reconstructive or plastic surgeon and a radiotherapist. The plan of treatment is tailored to fit a patient's requirements. If necessary, chemotherapy may become an add-on.

Treatment strategies:

The bastions of treatment for hypopharyngeal cancer are radiation therapy and surgery.

Surgery is the commonest treatment used, where part of the lining of the chest and abdomen may be removed and some of the tissues adjacent to it. It also may require removal of a lung, a procedure known as pneumonectomy, and sometimes part of the diaphragm may also have to be removed.

The alternative local therapy to surgery is radiation therapy. This involves the use of high energy, penetrative rays to destroy cancer cells. It affects cancer cells only in the zone treated. Radiation therapy is also employed for palliation i.e. control of symptoms alone in an advanced cancer.

Radiation therapy can also be used in adjunct to surgery or chemotherapy, either before or after.

Teletherapy or external radiation is given via a machine remote from the body while brachytherapy or internal radiation is given by implanting a radioactive source within the involved tissues. Patients may or may not require both modalities of radiation.

Radiotherapy, after initial planning, usually takes just 5 to 10 minutes per day, 5 days a week for about 6 weeks. This time period is flexible depending upon the modality of radiation used.

Besides local therapy, the best attempt to control cancer cells circulating in the body and lodged at places other than the soft tissues is by using systemic therapy (therapy which affects the entire systems of the body) which is in the form of injections or oral drugs. This form of treatment is called chemotherapy.

This form of treatment is given in a cyclical manner (each set of drugs is repeated usually after every 3-4 weeks).

Chemotherapy can also be used in combination with surgery, radiotherapy or both, either before or after.

If excessive fluid is collected in the pleura or in the peritoneal cavity, the doctor may have to remove the fluid by introducing a needle into the chest or abdomen and then putting a drain or a catheter inside and producing a gentle suction to tap the pleural and peritoneal cavities dry. This procedure is known either as thoracocentesis or a peritoneocentesis respectively. The doctor may also introduce special chemotherapy drugs or other drugs such as talcum powder to prevent the fluid from accumulating again inside the chest cavity.

Intraoperative photodynamic therapy is a state of the art treatment that uses special drugs and light to sensitize cancer cells during surgery. The drug that makes cancer cells photosensitive is injected into the vein prior to surgery. Afterwards, during surgery, as much cancer as is possible is removed (debulking), and a special form of light is shone onto the pleura or the peritoneum. This treatment is still being studied for early stages of chest wall mesotheliomas or pleural mesotheliomas.

What are the side effects of treatment for Mesothelioma?

	Unfortunately treatment for cancer does cause damage to the healthy tissues. Please ask the clinician about any possible side effects before any form of treatment commences. The effects of radiation depend upon the dose of radiation, the size of the area radiated, and the number and size of each fraction. The commonest side effect is extreme fatigue. Although bed rest is good, most radiotherapists advise the patient to be as mobile as possible. Another common problem is that of radiation dermatitis in which the skin covering the radiated area becomes red, dry, itchy, and may show signs of scaling off. This will slowly settle down after radiation ceases, but there may be a permanent 'bronzing' of the skin. It is important to note here that this skin problem is associated only with teletherapy or external radiation therapy. Radiation also may cause nausea and vomiting, diarrhea, urinary discomfort. There may also be a fall in the white blood cells, which are needed by humans to fight infection. Usually the radiotherapist can suggest the drugs and diet necessary to alleviate such problems. The various drugs used in chemotherapy cause a varied spectrum of side effects. The severity and variability of these symptoms are very individualistic, changing from patient to patient. Some of the common side effects are:
		Skin rashes.
		Loss of hair.
		Diarrhea.
		Vomiting.
		Tingling and numbness in the fingers and toes.
		Hearing loss.
	Most are temporary and recede after therapy is over. Hair growth gradually starts after cessation of chemotherapy. The medical oncologist (chemotherapist) will usually be able to reduce the severity and spectrum of these side effects. The psychology of the patient is very important during therapy. Better psychologically prepared the patient is, better are his chances of having decreased side effects. The patient should drink large quantities of water while the therapy is in progress, and preferably avoid uncooked or raw food. Water should be filtered or boiled. Any relative or person who has any sort of infection such as common cold should be asked to desist from coming close to the patient.

	What is the importance of follow up?

The importance of followup cannot be overemphasized. It is a fatal fallacy to assume on the patient's part that once the primary or the first phase of treatment is over, then he or she is cured. It must be stressed here that cancer has a notorious proclivity of coming back again and again. The only way to fight this is to pick up any problem when it is still early, so that it can be nipped in the bud. And the only way to do this is to follow up when the doctor calls you for the next visit. Each such visit will include a detailed history, a physical examination (including an internal i.e. a rectal or vaginal examination), a chest x-ray, an ultrasonography or a CT scan, and various other blood studies as indicated.